(162) Preliminary associated characteristics of the top 10% of GLP-1 spenders in a self-insured health plan

Background: : The utilization of GLP-1 therapies has increased substantially in recent years, resulting in a sharp rise in medication costs for health plans. Identifying characteristics of the top spenders on GLP-1 drugs may support strategic planning for cost control within this drug class.

Objective: : To determine the characteristics associated with the top 10% of GLP-1 spenders in a large, self-insured health plan.

Methods: : A self-insured commercial health plan covering over 18,000 members, primarily in Western states, was analyzed. The study included all GLP-1 pharmacy claims from 01/01/2024 to 12/31/2024. Top spenders were defined as the top 10% of members based on total plan-paid costs for GLP-1 therapies. Statistical comparisons between top and non-top spenders were conducted across age, gender, GLP-1 utilization patterns, diagnosis (based on ICD-10 codes), comorbidities (hypertension and hyperlipidemia), and appropriateness of use. Logistic regression was performed on selected variables to identify predictors of high spending.

Results: : A total of 761 unique GLP-1 users were identified, generating a total GLP-1 cost of $4,493,990. The top 10% (77 members) accounted for $965,226.30 in plan-paid costs. Compared to non-top spenders, top spenders were significantly older, had more claims and days supplied, more comorbidities, were more likely to have hyperlipidemia, and were more likely to use Mounjaro and Wegovy but less likely to use Zepbound (p < 0.01). Logistic regression indicated that being over 50 and using Wegovy or Mounjaro were strong positive predictors of being in the top 10%. Use of Zepbound was associated with a 77% lower likelihood of being a top spender.

Conclusions: : This study identified key characteristics of the top 10% of GLP-1 spenders: older age, use of Wegovy and Mounjaro, and lack of Zepbound use. Targeted educational and strategic initiatives may help control costs and improve outcomes. These findings are limited to one large, self-insured commercial plan; broader studies are needed to generalize the results.

Sponsorship:: MedImpact Healthcare Systems, Inc.